Today we celebrate step 4! This month we also celebrate 6 years of placing babies skin to skin (STS) with their mothers (and sometimes fathers) here at Memorial Hospital of South Bend. I’m often asked how we did it. Below is our self-assessment for step 4 followed by part 1 of a series of interviews describing how we made STS care of the newborn after delivery our norm.

STEP 4. Help mothers initiate breastfeeding within an hour of birth.

4.1 Are mothers who have had healthy vaginal deliveries given their babies to hold STS within 5 minutes of delivery, and allowed to remain with them in uninterrupted STS contact until completion of the first feed? Yes

If yes, what percentage of mothers who had normal, vaginal deliveries are given their babies to hold STS within 5 minutes of deliver and remain uninterrupted STS until completion of first breastfeed or for at least 1 hour if not breastfeeding?

100% of babies at Memorial are placed immediately on their mother’s skin unless there is a medical reason to take the baby to the warmer.

4.2 Are the mothers offered help by a staff member to recognize signs that their baby is ready to feed and provided assistance with initiating breastfeeding during this first hour? Yes

4.3 Are mothers who have had cesarean deliveries given their babies to hold, with STS contact, within 5 minutes after they are able to respond to their babies? Yes

If yes, what percentage of mothers who had cesarean deliveries are given their babies to hold STS within 5 minutes after they are able to respond to their babies?

All healthy newborns are placed on their mother’s bare skin before leaving the operating room.

4.4 Do the babies born by cesarean section stay with their mothers, with uninterrupted STS contact, until completion of the first feed? Yes

If yes, what percentage of babies born by cesarean section stay with their mothers, with uninterrupted STS contact, until completion of first breastfeed or for at least 1 hour if not breastfeeding?

100% stay with their mothers for the entire recovery unless they require care in our Level III NICU. If baby goes to the NICU, we help the mother pump her breasts in recovery and deliver any colostrum pumped immediately to the NICU.

My first interview is with Patty DeStefano, R.N., MSN, director of the Memorial Childbirth Unit (CBU). In 2006, when we implemented our policy called, Care of the newborn immediately following delivery, Patty was the CBU manager. Her role has since changed, but her commitment to equipping nurses to put into practice current, evidence-based care remains the same.

How did the idea of placing babies skin to skin after delivery at Memorial begin?
My recollection is it was a project or somehow part of Karen’s midwifery schooling. [Karen was our Perinatal Services manager. She is currently a local midwife and faculty at Frontier Nursing University.] I think it was something she was studying and we all thought, “Why aren’t we doing this at Memorial?”

Why make it a policy? Why not just educate nurses that it is a good idea?
When you are working with 70 nurses and 35+ physicians, you have to make something like this a policy to make sure it gets done, time after time, delivery after delivery.

How did you create buy in?Karen did a presentation at our annual R.N. skills sessions which included a 20-minute clip from the DVD What Babies Want. (Click here to watch a clip of this film.) Noah Wylie was the narrator. After watching the film clip, there wasn’t a dry eye in the room … the nurses who had been helping to bring new life into the world for many, many years felt badly for what they had not been doing. Why hadn’t we been doing this sooner? Had we done harm to families? They wanted to do the right thing, and they started immediately. I recall it being a wonderful time on the unit.

Was there resistance, and from whom?I remember anticipating the more experienced nurses were going to have trouble with doing skin to skin. That wasn’t how it was. It ended up being the younger nurses having trouble because they were focused on their “nursing tasks.” It was hard for them to simply let the family be. The more experienced nurses were able to get the room cleaned up, do some wrap-up charting and let the family get to know each other. They were OK with the process. As far as the physicians, the only thing I remember about resistance from them was having a hard time not being able to document the baby’s weight in their charting. That was really the only physician resistance I recall … “Can you just take the baby and get the weight really quickly?”

How did you overcome this resistance?We had champions that were so great about doing skin to skin. We would have them share different techniques: how they prepared the mom for skin to skin, how they explained it to the mom, how they would put their blankets, towels, etc. I remember telling charge nurses they had to make sure that skin to skin was taking place, and for those who were having trouble, they had to be the leader and quietly show how it was done. The charge nurses were making sure policy was followed.

Does change like this happen best as a top-down process or the other way around?Both. It is very typical of the CBU nursing staff that when the research is presented, they jump in. They do it without much resistance. I think it gives credit to nursing and the professionalism of our staff. It was the same way with “laboring down.” We presented the research, and they made it happen. Credit must be given to the nurses at the bedside.

Do demographics matter? In other words, are people from certain socio-economic, racial or ethnic backgrounds more likely to reject or embrace this practice?I don’t think it matters. What is really important is how the nurse explains skin to skin to the patient and her support person. How passionate she is … does she believe what she is saying? Again, it’s up to nursing.

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About blogtobabyfriendly

blogtobabyfriendly is written by Amy Murray, a Childbirth Unit nurse with a touch of earth muffin crunch. A childbirth educator and IBCLC, she's been a breastfeeding advocate all her adult life, believing that if our bodies make milk, it just makes good sense to feed it to our babies. blogtobabyfriendly is her hospital's journey to Baby-Friendly designation. Click to get email updates on new blog posts. Our desire is to learn, share, and learn more.

14 Responses to Celebrating Step 4: Help mothers initiate breastfeeding within an hour after birth

Having had two babies born by cesarean section at memorial, I don’t know that I recall the skin to skin in the operating room. I was pretty out of it so I could very likely be mistaken. The baby was brought to me to see but my arms were not ready to hold the baby. I do remember skin to skin time through the first feeding in the recovery room. Both babies traveled on me from there to our room. I loved having that special bonding time with both of my babies. Memorial does an exceptional job, in my opinion, of educating parents.

That sounds lovely Olivia! It is not our policy to place babies skin to skin with their fathers or other support person when mom is not able, but it is a very common practice for us. Thanks for sharing!

I just had a baby in Nov of 2011 at Memorial and I loved the skin to skin. I had no idea Memorial did the skin to skin, and at first was curious why they didn’t take her weight right away, but in the end that didnt matter. I loved having that special bonding time with my baby so much!! It was incredible, probably my most favorite hospital memory.

So nice to read the positive experiences people have had with skin to skin! Comments have been flying on Facebook as well, including sad stories of babies being taken away for hours at other hospitals for routine care. I’m not saying we’re perfect, but Memorial Childbirth Center has cultivated a culture in which evidence based care is both embraced and enforced. We have fantastic leadership and equally fantastic nurses and support staff. If you’re looking for job or a place to have a baby, South Bend, IN is a good place!

As a labor nurse at Memorial, I love explaining skin to skin to my patients and telling them about the wonderful benefits of holding their babies close against their skin right after birth. It is such a magical, beautiful time for new families. I am so fortunate to work in an environment that provides this time for every new family.

I think it is wonderful that the LD staff have implemented the innovative processes such as Skin to Skin with newborns and their mothers. It is not required rather just plain important and valuable.
I am a nurse on the pediatric unit at Memorial, so I understand the task oriented duties that a nurses and physicians face, but I really appreciated the extended STS time that my 3rd baby and I were allowed to experience. I recall back to 2002 and I was able to have STS at that time with my 1st as well but it was shorter. In 2005 my son experience a fractured clavicle durning birth related to shoulder dystocia, therefore he was slightly stressed so he went to the warmer right away. I must admit that while the skin to skin was valuable and important, I didn’t feel less bonded to my son for not having it right away. All 3 nursed as long as they wanted in the birthing suite and we were left alone as a family to bond in all 3 situations. I had 3 wonderful experiences that will forever be remembered!

I wish I could go back in time and experience STS contact with my children (13 and 10), but unfortunately I can’t. I can however, make sure I encourage STS with all families that I come in contact with and as a Charge Nurse, continue to enforce that standard when assisting with deliveries.
Not too long ago, while holding her infant in STS contact a mother looked at me with the most sincere expression and asked ‘how much does the baby weigh?’ I thought to myself, ‘unless your bare chest doubles as a scale, I wouldn’t know.’ 🙂 I realized how attached patients, doctors, and nurses were to getting a weight and other tasks done immediately after birth. When I started as a Clinical Associate in 2000, I was so excited to ‘catch’ baby after delivery and help with those tasks. Now, 12 years later the buzz is out that Memorial Hospital Childbirth Unit does what is best for mom and baby. Maybe in the near future, we will figure out how to weigh babies on mom’s chest…we’ll keep you posted!!!

Going back in time would be lovely wouldn’t it? I wish I could redo my first labor!! I laid in bed and refused to get up. Oh how my labor would have been so much shorter had I moved around a bit! I learned the second time and I stayed out of bed as much as possible. That experience was truly more positive. Thank you to everyone that believes in skin to skin, knows that we are helping families to bond and hopefully are helping to change our community for the better!!

I just give birth to my daughter 12 days ago and the STS time with her right after birth is by far one of my favorite memories. I was thrilled that I was able to do this right away and for such an extended period of time. I was able to start breastfeeding right away and she’s been a great little eater ever since. I know that I made the right choice in choosing to birth our children at Memorial. I think that everyone is doing a great job now, so I can’t even imagine how much better it will be through these changes. Way to go!

A mother who is shown how to hold her baby skin-to-skin and watch him self-attach in a relaxed, golden first hour after delivery has been given a gift of trust that her baby’s curiosity and instincts can guide her when she has no idea of where to go. Thank you for all that you do at your hospital to give your mothers and babies a great start!

I agree. I think we do such a great job as a team helping moms start breastfeeding in that first hour of life. Speaking from experience, I have four children ages 22 to 3 yrs. I was 19 when I had my first daughter. I didn’t have any support in breastfeeding with her in the hospital or at home. I wound up only nursing her for only a few weeks. She wound up with a lot of GI issues. I had such great support and education with my other children and had a wonderful experience with assistance on breastfeeding with my 3 year old that I was able to be confident enough to breastfeed him for 19 months!!! I hope to help all of my patients with the confidence they need to start off being successful at nursing and bonding with their baby. I think this is honestly the best gift we can give them!